Impact of wrist-ankle acupuncture on propofol dosage under the dual monitoring of density spectrum array and anesthesia consciousness index in elderly patients undergoing urologic surgery: a sham-controlled randomized clinical trial.

Background: Propofol is a widely used intravenous anesthetic in clinic. However, it is easy to cause serious circulatory fluctuation in elderly patients, so the dose should be reduced as appropriate. Studies have shown that wrist-ankle acupuncture (WAA) can reduce the dosage of propofol in patients undergoing painless endoscopy. Unfortunately, there is no report on whether WAA will reduce the dosage of propofol when used for anesthesia in elderly patients. The purpose of this study is to observe the effect of WAA on propofol dosage in elderly patients, and to provide a new method for maintaining circulatory stability in elderly patients under general anesthesia. Methods: From October 2022 to December 2022, Hebei Provincial Hospital of Traditional Chinese Medicine was selected. Forty-four elderly patients undergoing general anesthesia in urology department were randomly divided into two groups according to the complete random method with WAA group, consisting of 22 individuals, and non-WAA (NWAA) group, also consisting of 22 individuals. Both groups were treated with WAA or false needle acupuncture at the same site before anesthesia, respectively, and the needle was kept until the operation was finished. During the operation, the dosage of propofol was adjusted according to the depth of field monitoring density spectrum array (DSA) and anesthesia consciousness index (Ai) with anesthesia monitor. Results: A total of 44 patients participated in this study, and all of them completed the experiment. There were no significant difference in sex, age, height, weight, duration of anesthesia, liver and kidney function, score of Fried frailty scale, activity of daily living (ADL), age-adjusted Charlson comorbidity index (aCCI) and mini-cognitive test (Mini-Cog) between the two groups (P>0.05), but the total dose of propofol (WAA =121.5, NWAA =170.5) mg and maintenance dose (WAA =1.02±0.55, NWAA =1.76±0.67) mg/kg/h, utilization rate of vasoactive drugs during operation, recovery time after anesthesia (WAA =2, NWAA =3) min and surgeon satisfaction (WAA =9, NWAA =8.5) had significant differences (P<0.05). Conclusions: Compared with NWAA group, WAA group could reduce the dosage of propofol in anesthesia for elderly patients with exocrine secretion and was beneficial to circulatory stability. Trial Registration: Chinese Clinical Trial Registry (ID: ChiCTR2100054132).

Clinical study on effect of wrist-ankle acupuncture on incidence of hypertension after intubation during induction of general anesthesia.

OBJECTIVE: To observe the effect of wrist-ankle acupuncture on the incidence of hypertension after tracheal intubation during induction of general anesthesia. METHODS: 200 patients receiving selective surgery under tracheal intubation and general anesthesia in our Hospital were selected and divided into control group and wrist-ankle acupuncture group using the random number table method, with 100 patients in each group. Sufentanil, cisatracurium besilate, remifentanil, etomidate and lidocaine hydrochloride were used for anesthesia induction, and intravenously injected according to the onset time of drugs, successively. The wrist-ankle acupuncture group was needled in bilateral upper 1, 2 and 3 areas, while the control group was treated with false acupuncture.Blood pressure and related blood biochemical indexes were measured and observed at different stages in each group. RESULT: The incidence of blood pressure exceeding 20% and 30% of basal blood pressure within 5 minutes after intubation was as follows:wrist-ankle acupuncture group 11.83% and 6.45%; control group 29.79% and 22.34%, The incidence in the study group was lower than that in the control group. Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that before induction (P < .05), and plasma Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that in the control group after intubation (P < .05). The plasma Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that in the control group after intubation (P < .05). CONCLUSION: wrist-ankle acupuncture can prevent hypertension after intubation during anesthesia induction. Moreover, it is safe, effective, minimally invasive. Therefore, it is easy to be popularized in clinical practice.

Reduning plus ribavirin display synergistic activity against severe pneumonia induced by H1N1 influenza A virus in mice.

OBJECTIVE: To investigate synergistic effect of Reduning (RDN) injection plus ribavirin against severe pneumonia induced by H1N1 influenza A virus in mice. METHODS: We established a mouse model of severe pneumonia induced by influenza A virus by infecting Balb/c mice with CA07 virus. We randomly assigned the infected mice into four groups, and treated them with normal saline (NS group), RDN (injection, 86.6 mg/kg), ribavirin (injection, 66.6 mg/kg) or double Ribavirin plus RDN group, the same dosage as used in the single treatments) for 5 d. Lung index and lung pathology were recorded or calculated in terms of the curative effective. Cytokines, NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome related protein including caspase-associated recruitment domain (CARD) domain Apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC), caspase-1 and NOD-like receptor family, pyrin domain containing 3 (NLRP3), and reactive oxygen species were simultaneously investigated. RESULTS: RDN plus ribavirin treatment, not RDN or ribavirin alone, provided a significant survival benefit to the influenza A virus-infected mice. The combination treatment protected the mice against severe influenza infection by attenuating the severe lung injury. The combined treatment also reduced the viral titers in mouse lungs and lung index, downregulated their immunocytokine levels, including IL-1ß and IL-18, and down regulated the NLRP3, especially the transcription and translation of caspase-1. Meanwhile NS group had significantly higher reactive oxygen species (ROS) expression which could was dramatically reduced by the treatment of RDN plus ribavirin. CONCLUSION: Our study showed that RDN combined with ribavirin could protect the mice, and reduce the lung immunopathologic damage caused by severe influenza pneumonia. The mechanism could be that it reduced ROS produce and inhibited NLRP3 inflammasome activation so that mainly lower the downstream inflammatory cytokines IL-1ß and IL-18.

Prevention and treatment of infectious diseases by traditional Chinese medicine: a commentary.

The present review aimed to summarize the effectiveness and features of traditional Chinese medicine (TCM) for the treatment of infectious diseases and to discuss the limitation of the development of TCM. The personalized medicine with TCM exerts a curative effect on viral and bacterial infectious diseases with unique advantages on the improvement of clinical manifestation, pathogen inhibition, and organ recovery during severe and drug-resistant infection. The deficiency of personalized medicine with TCM lies in that the current research design of TCM primarily focuses on the study of the effective components and material basis of Chinese herbs at the cellular, molecular, and genetic level, while ignoring the guidance of the TCM syndrome differentiation theory, which is the core concept of individualized treatment. Personalized medicine with TCM has a broad prospective for infectious diseases due to the specific efficacy and advantages. While the curative effect of individualized treatment with TCM cannot be excluded from the TCM syndrome differentiation theory, the study of personalized medicine with TCM for infectious diseases urgently requires a unified standardization of the clinical syndrome differentiation and the evolution rule of infectious diseases by TCM theory.

Combination of ribavirin and reduning protects mice against severe pneumonia induced by H1N1 influenza a virus.

OBJECTIVE: To investigate the effects of ribavirin administration combined with Reduning in a mouse model of influenza A (H1N1)-induced severe pneumonia. METHODS: Influenza A/Beijing/501/2009 (H1N1)-infected C57BL/6 mice were randomly divided into four experimental groups treated with either a mock injection of phosphate-buffered saline (PBS), ribavirin (66.6 mg/kg daily) or Reduning (86.6 mg/ kg daily), or a combination of both, for 7 days. Mice were monitored for clinical signs and survival, and body weight was measured daily for 14 days. Virus titer, lung wet-to-dry ratios, pathology and cytokines including interleukin (IL)-6, IL-10, and interferon (IFN)-γ were assayed on different days. RESULTS: In the untreated group injected with phosphate buffer saline, all the mice died of the infection. The survival rate of mice treated with Reduning was only 10%, whereas 100% of the ribavirin- and the combination-treated mice survived. Low lung viral loads indicated that ribavirin significantly inhibited virus replication, whereas Reduning did not. Lung wet-to-dry ratios demonstrated that both ribavirin and Reduning, administered together or separately, reduced acute lung edema compared with results in the untreated group. Pathology analyses also showed that treatment with a combination of both drugs relieved pathological lesions, whereas the single drug treatment did not. Levels of IL-6, IL-10 and IFN-γ in mice treated with ribavirin or the combination of both ribavirin and Reduning were all significantly lower than in the untreated group, especially in the combination-treated group. In addition, Reduning administration significantly decreased both IL-6 and IL-10 production but had no effect on IFN-γ. CONCLUSION: Due to the synergistic effect of antiviral and antiinflammation, the combination of ribavirin and Reduning could be an effective treatment for severe H1N1 which was considered to be significant to delayed antiviral and drug resistant.